The Affordable Care Act (ACA) was signed in March 2010; that month, 57% of U.S. adults did something to self-ration health care, such as splitting prescription pills, postponing necessary health care, and putting off recommended medical tests, according to the Kaiser Family Foundation (KFF) Health Tracking Poll of March 2010.

As of September 2013, only 19% of U.S. adults said they had heard “a lot” or “some” about the health care law. 48% had heard “nothing at all,” and 1/3rd said they’d heard “only a little.”

Among all U.S. adults, only 15% said the health insurance marketplaces would open on October 1st – which includes people who just said, “October.”

39% of people felt favorably (net very and somewhat) toward the law, and 43% were not favorable to it (net very and somewhat) in the days leading up to opening up the health insurance shopping sites across the nation. 17% said they still didn’t know how to feel about the health reform bill, according to the poll.

At the same time, 56% of people said they disapproved of cutting off funding for the ACA. Nearly the same percentage, 51%, say they don’t have enough information on how the law would affect them and their families. Two-thirds of people said they hadn’t tried to seek out more information about the law. Nor had most people (56%) even seen or heard ads about the law, according to the September 2013 poll.

See the pie chart, asserting that “half do not trust any media source for ACA information.” Were people to look for information on the health care law, note what news media sources would be most trusted: across all media, Cable TV outlets rank tops with 42% of U.S. adults turning there, with Fox News ranked #1 at 21%, CNN second with 11%, MSNBC with 5% and other cable networks, 5%. Broadcast TV ranks second across media types with 16% of people looking to either the big networks (9%) or local TV news (7%). Newspapers rank third of all media types, with 15% of people looking to paper (New York Times with 4%, Wall St. Journal with 2%, and other papers totaling 9%). Public radio garnered 9% of U.S. adults’ most-trusted source for information about health care reform.

Among those people taking the survey, 81% were covered by health insurance and 19% were not.

Health Populi’s Hot Points: The KFF Health Tracking Poll has monitored U.S. adults’ perspectives on the American health system for more than a decade, and has asked the question about whether cost has prevented people from getting health care since the year 2000. Back then, 13 years ago, 15% of people said that cost prevented them from getting a recommended medical test or treatment, and 13% from filling a prescription drug.

Today, those numbers are 26% and 27%, respectively, as illustrated by the first chart.

While people are self-rationing care, they remain confused about legislation that was signed into law about a subject about as important as any affecting their lives. Yet, with 81% of U.S. adults saying they were covered by health insurance, most people clearly haven’t been proactive in seeking information about the ACA.

Even with advertising and promotions from credible government and commercial insurance sources — as well as more scam-type communications proliferating across media channels – 56% of people said they’d seen no ads about the law.

Perhaps we could have used a Dummies guide, and one particularly translated into engaging Spanish and for younger people who have lacked cost-favorable insurance. We haven’t seen social media channels and digital and interactive tools leveraged that people like to use every day. How about a cool gamified app that would have educated people and been fun to use? Or a great YouTube video that would have gone viral and made it cool to think about, and buy into, health insurance?

Those who were responsible for promoting the positive aspects of the Affordable Care Act really dropped the ball. Who might have been helpful? Here are ten creative marketers.

When will the U.S. health ecosystem embrace the fact that we are in a new kind of retail when it comes to health? We do, at THINK-Health, HealthcareDIY, and on this Health Populi blog.

About Jane & Health Populi

Jane Sarasohn-Kahn is a health economist and management consultant that serves clients at the intersection of health and technology.

Her clients include all stakeholders in health, including providers, payors and plans; companies in biopharma, medical devices, financial services, technology and consumer goods; non-profits and NGOs. Jane's lens on health was best described by Dr. Regina Benjamin, U.S. Surgeon General, who says that health is where we live, work, play and pray.